Recent Changes To New York’s Workers’ Compensation Guidelines

In November 2011, the New York State Workers’ Compensation Board announced that after more than 15 years it was revising its guidelines for determining levels of incapacity and wage loss from on-the-job injuries. Effective January 1, 2012, the 2012 New York State Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity will help medical professionals, lawyers and insurance carriers evaluate and analyze medical impairment and physical function associated with work-related injury.

The updated guidelines address both schedule and non-schedule awards. Schedule awards relate to permanent impairment of extremities, hearing loss, vision loss or disfigurement of the face. Rules for deciding loss of use schedule awards are very technical and specific. Non-schedule awards cover permanent impairments not covered by a specific schedule. Common examples include issues related to the heart, brain, lungs, skin, spine and major joints.

The 2012 Guidelines leave unchanged the scheduled loss of use awards from the 1996 Medical Impairment Guidelines. The rules and guidelines for non-schedule awards underwent significant revision after evaluation by the Insurance Department’s Workers’ Compensation Reform Task Force and Advisory Committee (Task Force).

Maximum Medical Improvement

One major change in the 2012 Guidelines is the baseline definition of maximum medical improvement (MMI) before determining both schedule and non-schedule disabilities. The Task Force provided the following MMI definition:

“A finding of MMI is based on a medical judgment that (a) the claimant has recovered from the work injury to the greatest extent that is expected and (b) no further improvement in his/her condition is reasonably expected. The need for palliative or symptomatic treatment does not preclude a finding of MMI. In cases that do not involve surgery or fractures, MMI cannot be determined prior to 6 months from the date of injury or disablement, unless otherwise agreed to by the parties.”

Wage Earning Capacity

The Task Force also provided a three-prong analysis for loss of wage earning capacity determinations:

• Evaluation and ranking of medical impairment
• Evaluation of functional ability/loss
• Determination of loss of wage earning capacity based on impairment, function and vocational factors (including education, skills, literacy, age, etc.)

The goal of the 2012 New York State Guidelines for Determining Permanent Impairment and Loss of Wage Earning Capacity is to provide lawyers, medical professionals and claims professionals with the tools they need to evaluate and successfully resolve workers’ compensation claims.

If you or a loved one has a potential job-related injury claim, contact an experienced workers’ compensation attorney to discuss your situation and your options.